Question 1

Biomechanical Assessment

Accepted Answer

Professional assessment of your feet and shoes is known as a biomechanical assessment. This type of assessment can give a bigger picture of what is happening with your body. Orthotic devices and supportive footwear may be prescribed.  These can make a great impact on the alignment of your body, and take pressure off knees and your lower back.

Question 2

Blisters

Accepted Answer

The feet are particularly prone to blisters. Ill-fitting shoes or friction can damage the skin, and a blister forms due to the body’s response to injury or pressure. 
 
Depending on the cause and location, a blister can range from the size of a pinprick, to two centimeters or more in diameter. 
A blood blister is usually caused by a severe pinch or bruise to the skin that breaks the tiny blood vessels (capillaries). 
 
Symptoms 
 
The symptoms of a blister include: 
Reddened and tender skin patch 
Raised lump filled with clear fluid 
Sometimes, the lump is filled with blood. 
 
Causes 
 
A blister is usually the body’s attempt to cushion the underlying skin tissues from further damage during the healing process. Some common causes of blisters include: 
Ill-fitting shoes 
Friction 
Scalds or burns 
Severe sunburn 
Allergic reaction to irritants 
Viral skin infection (such as herpes/warts) 
Fungal skin infection (such as tinea). 
 
Treatment 
 
Blisters rarely need medical attention, unless they are severe, recurrent, caused by burns or indicative of an underlying infection. Suggestions on treating a simple friction blister yourself include: 
 
Resist the temptation to burst the blister. You could cause an infection or hinder your body’s healing process. 
If the blister has burst, don’t peel off the baggy skin pocket – let your body heal the area in its own way and in its own time. 
Frequently wash the area with salt water and keep it free from dirt or irritants. 
If the site of the blister makes it vulnerable to popping (for example, a blister on your foot may be broken by the friction of socks or shoes), pad it with a soft dressing, securely taped. 
Don’t use tape alone, as removing the tape may rip the skin off the blister. Change the dressing daily. 
If the blister breaks, press gently to remove the fluid and apply an antiseptic (such as betadine) to reduce the risks of infection. 
 
Seek medical attention ie your doctor or other health professional for treatment if: 
The blister is caused by burns, scalds or severe sunburn. 
The blister starts weeping pus. 
The area becomes increasingly swollen or inflamed. 
You suspect the blister is caused by some type of skin infection or allergic reaction. 
 
How can we help you!
 
Depending on the cause, treatment options may include: 
 
Proper drainage of fluid 
 
We may use U pads to go around the blister to take pressure off the blister, so it is not painful to walk on.
 
Assessment of your footwear may also help assess the cause of the blisters. You may have some abnormal biomechanics that may be causing excessive friction.
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Prevention strategies include: 
 
Wear properly fitted shoes. 
Choose moisture-wicking socks (socks that draw sweat away from your feet) or change socks twice daily if you have sweaty feet, as wet socks cause friction and rubbing. 
Change damp socks promptly, as wet socks can drag against the skin. 
Wear ‘sports socks’ when exercising or playing sports. They have padding over bony prominences and under the ball of the feet.
If you become aware of a localized ‘hot’ area on your foot, stop your sport and tape the area immediately. 
Apply a foot spray deodorant to reduce sweating and thereby reduce the risk of fungal infection.

Question 3

Bunions

Accepted Answer

A Bunion deformity refers to the enlargement of the first MPJ or metatarsophalangeal joint. 
 
Initially the bunion represents the bony prominence of the 1st Met head as the hallux is abducted towards the second toe. 
 
As the big toe moves towards the 2nd toe, bony changes or osteophytic growths occur at the margins of the joint over time, due to constant irritation. 
 
 The hallux becomes increasingly abducted, sometimes forcing the 2nd toe to over-ride the hallux. 
Tendons, ligaments, and sesamoid bones also become laterally deviated. The 3rd, 4th, and 5th toes can become clawed. 
 
The medial prominence of the 1st Met head can also develop a bursa or fluid sac under the skin of the bony prominence when subject to friction or shoe pressure. 
 
Progressive degeneration or osteoarthritis occurs at the 1st MPJ, joint margins, including the 1st Met head. 
 
Causes:
 
1/- Tight Footwear that squeeze the toes together can be a contributing factor.
 
2/- Hereditary: Although bunions are not directly inherited, foot shape, biomechanics, ligamentous strength, are definitely inherited. 
 
3/- Foot Structure. If the angle between the 1st and 2nd Metatarsals is greater than 10 - 15 degrees, the chance of developing HAV is far greater. 
 
4/- Abnormal biomechanics of the feet / legs can result in abnormal forces and alignment at the big toe joint or 1st MPJ. This can be a result of excessive foot pronation. 
 
Pronation is a word that describes the position and motion that occurs at the heel joint and midfoot joints resulting in the overall effect of; - internal leg rotation - collapse of the arch (eversion) - and abduction of the forefoot. Pronation also causes loss of function of the peroneus longus muscle that stabilizes the 1st metatarsal and 1st MPJ joint, thus adding to the instability of the big toe joint during gait. Jamming of the 1st Metatarsal can cause destruction of the cartilage at this joint, resulting in reduction in joint range of motion.
 
5/- Ligamentous Laxity is a term that describes the flexibility or the strength of the ligaments that support the bones of the feet. If ligaments are generally loose then gravitational and mechanical forces will easily overcome mechanisms that support the foot and alignment of bones in relation to joint position, thus resulting in foot pronation. 
 
6/- Tight Calf Muscles, The Gastrocnemius muscle, which becomes part of the Achilles tendon, can cause foot pronation if there is insufficient flexibility of the muscles. 
Tight Calf muscles are a common condition. Because the muscles are very strong they cause the foot to pronate at the midfoot during gait in order to get extra dorsi-flexion at the ankle during gait.
If the muscles are tight then the foot is forced to pronate, thus causing pressure on the big toe joint and other structures of the feet.
 
Treatments:
 
It is best to get a thorough assessment by the Podiatrist to see if there are any contributing factors that may cause abnormal forces at the big toe joint, or other factors that contribute to the formation of the bunion.
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1/ Corns and Callus debridement 
 
2/ Orthotic devices to control foot pronation 
 
3/ Calf stretching to reduce foot pronation forces.
 
4/ Exercises for feet to strengthen muscles 
 
5/ Massage and mobilization
 
6/ Footwear to support foot posture, thus reduce foot pronation.
 
7/ Stretching shoe over site of pressure on bunion
 
8/ Padding to cushion areas 
 
9/ Night splint to adduct hallux 
 
10/ Surgery to realign the 1st Met and hallux, remove bunion

Question 4

Childrens Feet

Accepted Answer

Children’s feet differ from those of adults, as they are not yet fully formed. 
 
Development
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During the Fetal period, the lower limbs start to bud around 3 to 5 weeks, followed by the nerve plexus and muscles, at 7 weeks. Between 8 weeks and 40 weeks, the differentiation of the embryo undergoes marked changes, forming the toes and other parts of the foot, which starts at the heel and ankle at 9 weeks. The metatarsal and toes form during the period from 16 to 20 weeks. At 21 weeks the heel bone starts to change from cartilage to bone. And at 37 weeks, the cuboid bone starts to ossify, indicating maturity of the embryo.
At birth, 40 weeks, the average length of the foot is 7.6cm.
 
From birth to 12 months the feet and legs go through a series of remodeling and alignment to prepare for crawling and walking. At six months of age the foot is still mostly cartilage; in fact, the last bone doesn’t begin to form until children are about three years old. 
 
From birth til age 6-7 years, dynamic changes occur in bone growth, alignment, muscular and neurological development.
Further final ossification of bone occurs, particularly the heel and Tibia bone, occur between ages 9 to 13, which children can experience inflammation of growth plates, eg Severs, Osgood Slatters. These conditions can be exacerbated by sporting activities.
 
By 18 years, most of the bones are fully formed, but they don’t fully fuse until 22-23yrs of age.
 
What to look for;
 
Babies
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Certainly, if there is an abnormal development of your baby’s feet, it may be good to check with the Pediatrician or Podiatrist to see if development is normal or not. If there is any abnormalities, many occur before the 7thembryonic week.
Structural abnormalities are usually picked up at birth. 
Neurological and muscular abnormalities are usually seen further down the track.
 
Baby feet only need protection in the cooler weather. Socks with soft natural fibres, should be used to keep feet warm and grow suits should always be loose around your baby’s feet, so they don’t cramp the toes.
 
Making time for your baby to kick freely will help with the development of the muscles in the legs and feet.
 
Walking
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Children usually begin to walk at any time between 10 and 20 months of age. It is important to remember that each child is unique and will move through the developmental stages at their own pace. Children also roll, crawl, walk and run in their own time.
 
When your child first begins to walk, shoes should only be used when protection is needed from the ground. Allowing children to go barefoot or to wear very soft shoes helps the foot to typically develop and assists in strengthening muscles, and sensitivity and development of nerves.
 
Sometimes children walk with their feet pointed inwards (in-toeing) or outwards (out-toeing). In most cases, these variations in walking are normal. Most children will grow out of these walking styles by the age of two, however it can sometimes take until the age of 12. If your child is not keeping up with their friends, or their legs are tired or are experiencing pain in their legs and feet, then best to take them to see a Podiatriast.
 
Children under the age of three may sometimes walk on their tip toes and this is a typical developmental stage. Any child over the age of three and still walking on their tip toes (toe walking) should be assessed by a podiatrist.
 
Growing feet
 
A child’s foot grows in length and changes in shape with growth. Arch development is an individual thing and arch height or a lack of an arch does not always indicate that a child will have problems with their feet. If your child has pain or has one flat foot that differs from the other foot, a podiatrist can assist.
 
Due to rapid growth in length and width while young, frequent changes in the size of shoes and socks may be necessary. Do a size check at least every one to three months up to the age of three, every four months up to the age of five and every six months from five years.
 
Heel pain
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Heel pain may also occur in growing children, usually between the ages of 8-14, and may be worse during or straight after sporting activities.
 
If your child is experiencing pain at the back of the heel that has limited their activity or causes them to limp, a podiatrist can help. 
 
Other area that may require professional Podiatry assessment and treatment may include knee pain, such as Osgood Slatters, or patella tracking issues.
 
It is important to assess gait, as abnormal forces on joints of the feet may cause issues further down the track, including spinal problems, such as Scoliosis.
 
Poor fitting or insufficient supportive shoes can contribute to problems as well. Bring in several pairs of shoes to your visit so we can assess any abnormal wear patterns that could be related to their gait. 
 
Skin and Nails
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Problems with the skin and nails on your child’s feet may occur from time to time. Some conditions (ingrown toenails, Athlete’s foot and warts) require treatment from a podiatrist, while others may be helped by changes in hygiene or shoes.
 
Children also tend to be more susceptible to warts than adults. A plantar wart is often on the sole of the foot and appears to be hard and flat, with a rough or ‘Cauliflower’ appearance. A wart may cause discomfort, as it presses on nerves.
A wart is caused by a virus, which causes the skin cells to grow rapidly, thus the unusual appearance.
Best to see a Podiatrist for a correct diagnosis.
 
Fitting footwear:
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Always have both feet measured for length and width.
The shoe should fit the natural shape of the foot, especially around the toes.
The toe of the shoe should allow toes to move freely and not be squashed from the top or the sides. Make sure there is about 1cm growing room for children between the end of the longest toe and the end of the shoe.
Shoes should fit comfortably around the heel and not be too loose or too tight.
Having shoes fitted by a store that offers trained assistants can help ensure the correct size and shape to keep little feet running and jumping.
 
What can we do for you?
 
A check-up with a podiatrist is recommended if:
 
You notice uneven shoe wear
 
You notice any skin rashes, hard skin, lumps or bumps on your child’s feet
 
Your child complains of recurrent pain in the feet and/or legs which also increases with activity
 
Your child is constantly tripping or falling
 
Your child walks on their tip toes
 
Your child’s walk does not look symmetrical (or the same on both feet and legs).
 
Or you have any other concerns about your child’s feet, or posture.

Question 5

Chronic Foot Pain

Accepted Answer

When we have been suffering from pain in our feet for long periods of time, we adjust and find ways to ignore, adjust and become accustomed to it. We avoid certain tasks, we don't walk long distances, we limp.  But chronic pain slows us down and prevents us from doing some of the things we want to do in life.
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There are literally dozens of caused for chronic foot pain.  At Daniel Lewis Podiatry, we use simple and non invasive tests to determine the cause of your pain is, and implement a treatment plan to effectively treat the pain and bring back the quality of life that you are looking for.

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Biomechanical Assessment

Blisters

Bunions

Childrens Feet

Chronic Foot Pain